Most women don’t give much thought to their genitourinary systems — as long as they’re healthy. But when there’s a problem, life can stop short fast.
Whether it’s the embarrassment and inconvenience of incontinence, the discomfort of recurrent urinary tract infections, or the excruciating pain of kidney stones, it’s important to consult a urology specialist for lasting relief.
Know that the female urinary tract is quite different than that of a male. If your primary care physician has recommended you see a urologist, consider choosing one who is attentive to the specific needs of women.
Dr. Meredith Lightfoot, a urologist on the medical staff at Texas Health Center for Diagnostics and Surgery in Plano, Texas shares, “Under 15% of practicing urologists are female, so a lot of female patients seek out me and my fellow female urologists in the Dallas-Fort Worth area. Thankfully, we’re all friends, and they’re all wonderful, so wherever you end up, you are in good shape.”1
Dr. Lightfoot added that urologists “are like the general physicians for the genitourinary system” — and that most people will need to see one sometime in their lifetime.
Here, she shares insights on common urologic conditions in women and how they are treated and managed.
Urinary Incontinence
A big proportion of female patients referred to urologists are dealing with some form of voiding dysfunction, especially urinary incontinence, according to Dr. Lightfoot. In general, there are two types of urinary incontinence: urge incontinence or stress incontinence.
Urge incontinence involves a sudden and frequent need to urinate. About 40% of women over the age of 40 experience this to some degree.
“These are the patients who tell me, ‘I know where every bathroom is and I don't sleep through the night,’” said Dr. Lightfoot. “We can treat that with options ranging from behavior modification and medication to more advanced interventions.”
Stress incontinence is the type that strikes when someone coughs, laughs, sneezes, jumps or runs.
“Those are our friends who can't go cheer on their kiddos at soccer games and who don't want to do the trampoline anymore, because they worry about having embarrassing urine loss,” said Dr. Lightfoot.
Exercises may help, but many women will need to consider surgery. Most of the options are quick, day surgeries that offer relief fast.
Another option is a procedure to bulk up the urethra.
“It’s similar to cosmetic injections used to make lips puffy and beautiful,” said Dr. Lightfoot. “The injections expand the walls of the urethra, and this squeezes down the diameter so that less urine will come out.”
“It does usually require repeated treatments but it’s a good choice for many patients,” said Dr. Lightfoot.
Another option is a mid-urethral sling — an outpatient surgery in which a tiny strip of mesh is inserted under the urethra.
“The mesh acts like a backstop, so that when the patient coughs or sneezes, they don't leak,” Dr. Lightfoot said. “If you and your doctor discuss the potential risks and benefits, and you feel comfortable with that, the sling can be a reasonable choice.”2
Recurrent Urinary Tract Infections
Most women will have a urinary tract infection, or UTI, sooner or later. UTI symptoms include pain or burning while urinating, frequent urination, blood in the urine, feeling the need to urinate despite having an empty bladder, or pressure or cramping in the groin or lower abdomen.3
Women are more likely to suffer from UTIs because their urethras are shorter and closer to the rectum, making it easier for bacteria to enter the urinary tract.4 Most patients will get relief with an antibiotic prescribed by their primary care physician, and have no further problems.
However, some women become prone to repeated urinary tract infections, particularly at midlife or later.
“It is so difficult to enjoy your life when you just don't feel well multiple times a year,” said Dr. Lightfoot. “There are some measures we can take to reduce your risk of recurring infection, and make sure there's not an underlying predisposing issue.”
If UTIs recur, it’s important to consult a specialist. The presence of blood in the urine should always be addressed, Dr. Lightfoot added.
“We want to make sure you don't have kidney cancer, bladder cancer, a kidney stone, or something of that nature,” she said. “If you have blood in the urine, let's make sure you raise your hand and get in front of your physician.”5
Kidney Stones
Over the course of their lifetime, one in ten people will have a kidney stone – and the rate of occurrence is rising.6
“Kidney stones are nobody's friend,” said Dr. Lightfoot. “And they're really common here in Texas — in fact, we're considered part of the ‘stone belt.’” Researchers think that the combination of long, hot summers (which contributes to dehydration) and the prevalence of obesity combine to make states in the south, including Texas, areas of high prevalence.
Symptoms of kidney stones include severe pain on either side of the lower back, or more vague pain or a stomachache that doesn't go away, blood in the urine, nausea or vomiting, fever and chills, and urine that smells bad or looks cloudy.7
Unfortunately, research shows that people who have kidney stones are likely to have them again.8
“The causes of kidney stones can stem from a lot of different issues,” said Dr. Lightfoot. “Some people have a genetic predisposition and have people in their family who have had stones. Diet may contribute, too.”
Most urologists can perform advanced metabolic work to determine the underlying issue, and address those with behavior modification and medication.
“In general, my advice to everyone is, keep that hydration up,” she said. “Try to increase your citrus intake. Watch your intake of oxalates. People who have kidney stones usually drink a ton of tea, or other high-oxalate foods like spinach or chocolate. I’m not telling everybody to give those up, but if you tend to form stones, you might want to cut down.”
There are a variety of treatments for kidney stones.
“Thankfully, we can treat any kind of stone at Texas Health Center for Diagnostics and Surgery,” she said. “We can do ureteroscopy, we have laser, we have lithotripsy. We can do whatever we need to do for one of our stone patients in a safe outpatient setting.9
The physicians on the medical staff at Texas Health Center for Diagnostics & Surgery in Plano, Texas, provide a wide range of nonsurgical and surgical treatment options for many urologic issues that affect women. For more information, please call the THCDS patient navigator at 972-543-1250.
[1] https://www.youtube.com/watch?v=n-91dv89PP8 [youtube.com]
[2] All Lightfoot quotes related to incontinence are from this video: https://www.youtube.com/watch?v=n-91dv89PP8 [youtube.com]
[3] Urinary Tract Infection Basics, CDC. https://www.cdc.gov/uti/about/index.html
[4] Urinary Tract Infection Basics, CDC. https://www.cdc.gov/uti/about/index.html
[5] All Lightfoot quotes related to UTIs are from this video: https://www.youtube.com/watch?v=n-91dv89PP8 [youtube.com]
[6] Preventing Kidney Stones – National Kidney Foundation: https://www.kidney.org/atoz/content/kidneystones_prevent
[7] Kidney Stones, National Kidney Foundation. https://www.kidney.org/atoz/content/kidneystones
[8] Preventing Kidney Stones – National Kidney Foundation: https://www.kidney.org/atoz/content/kidneystones_prevent
[9] All of Dr. Lightfoot’s quotes related to kidney stones: https://www.youtube.com/watch?v=td8AVK52fsA [youtube.com]